The Good Doctor (2017–…): Season 3, Episode 18 - Heartbreak - full transcript

Severe Winter Weather Advisories

have been issued from Kansas
to western Minnesota.

Severe ice and snow reported.

Temperatures will likely reach
below 20 degrees, and wind chill...



Mm. There is a severe
weather warning in Minnesota.

You haven't been at work
in three days.

I want to be left alone.

I'm sorry she hurt you.

But you are strong.

You're the most
determined man I know.

You're gonna get through this.

I wish I was...


Everyone wishes
they were normal, Shaun.

You need to get up.

You need to do
your exercise routine,

then shower, shave,
and get to work.

And not because your
patients need your help,

but because it'll
make you feel better.

I'm not leaving without you.

Your sleep apnea is worse
than we'd thought.

You have a condition related
to your pseudoachondroplasia

that is narrowing
the base of your skull

and compressing
the part of your brain

that controls your breathing.

People always say
I'm too full of myself.

Guess it's actually true.

Finn, this is serious.

Don't worry.
I'm gonna be fine.

We can remove bone
from the wall of your skull

and resect a small section
of your cerebellum

to reduce brain-stem pressure.

You're... You're gonna
cut out a piece of his brain?

It won't affect your intellect,

but it will cause
a speech impediment

and some difficulty
with balance.

I'd rather you knock
a few points off my IQ.

Stop it.

I'm serious.

My "gift of gab"
is what you love about me.

Uh, w-what's option two?

I'm sorry,
there is no other option.

I'm a salesman.
I don't hear the word "no."

Th-There's always another way.

You just got to think
outside the box.

We've already done that,

which is how we came up
with this surgery.

It's the only way
to keep you alive,

so you have no choice
but to accept it.

Dr. Murphy is being rude
and insensitive,

but he's also right.

Finn, please, I love you.

And I will always
be here for you

no matter how you talk or walk.

But you have to listen
to your doctors.

I love you, too.

Do whatever you think's best.

Let me guess.

I'm gonna need another surgery.

What's that now, my tenth?


And I still can't work the farm,

can't drive a tractor,
pull a combine lever.

I can't even
twist open a bottle of beer.

When we met,
you were in an ambulance

and your arms were still
in your harvester.

Today you have sensation
and almost full mobility.

Now we just need
to treat the neuropathy

and improve your strength.

So how do we do that?

I'm thinking a gracilis
muscle transfer.

That should improve his grip
and relieve some of the pain,

but there's only one way
to eliminate all of it.

Tyson, have you given
any more thought to amputation

and osseointegrated
prosthetic arms?

They'd attach
directly to the bones

and nerves in your forearm,

and you can control them
just like your own hands.

Function would be reduced
in some respects.

Less dexterity,
no sensory feedback.

But others, like grip
strength, would be better.

And more importantly,
you'd be pain-free.

I want to be a farmer,

not a cyborg.


The pain's getting worse.

Probably because I've been
crazy busy in the O.R.

with Murphy out till today.

He's back?

Only because Browne
went to his apartment

and dragged his ass in.

She shouldn't have done that.

He's trying to work
this out on his own.

That's a good thing.

DMARDs aren't working.

I know.

Which is why I've been thinking
about synovectomy surgery.

You're gonna remove the
joint linings in your fingers?

That'll resolve the pain

Then what?

It'll give me
at least ten years.

And then you're gonna be
bone on bone,

every joint in your hand
will be mangled and deformed.

What's your plan then?

Who knows what treatments
will be available in ten years?

Have you thought about oncology?

Surgeons do the real work.

They cut out the tumor,
they cure the patient.

Oncologists just sweep up after.

You want to know
an even better job?

Starting pitcher
for the Oakland A's.

You want to know
why I didn't get that job?

Because the scouts didn't like
the way you wore your hat?

Yeah, that, and I
was born with this arm.

You were born with those hands.

What are you gonna do,

practice surgery
for a few more years

and then spend
the rest of your life

not being able
to pick up a pencil?

You can pursue
another specialty.

You can practice
for the rest of your life.

You get rear-ended
on the way to work

or you just hate little people?

EKG is normal.

So you got dumped.

No, I didn't.

It's nothing to be ashamed of.

We were never even going out.


I've been worried sick.


Take it easy.

I told you to stay home.

There's nothing to worry about.

Stop trying to act so tough.

You shouldn't have to
go through this alone.

Sorry, baby,
but you should wait outside.

Let the doctors finish up,
and I'll be right out.

He's not going to the O.R.
for a while,

so there will be plenty of
time to visit when we're done.


I'll be right outside.

Is there any way
you could make sure

she and Nathalie
stay in separate waiting rooms

and aren't allowed to visit
at the same time?

No. We're not helping you cheat.

I'm not cheating.

I've always made it clear
I'm not ready to settle down,

but sometimes
women m-make assumptions.

Oh, and you don't feel
the need to correct that?

I understand you don't approve,

but all I'm asking

is for you to help me
get through brain surgery

without emotional turmoil

that I assume would be
harmful to my recovery.


Thank you.

Are you seeing
the same thing I'm seeing?

The tendons
are encased in scar tissue.

The gracilis muscle
transfer isn't gonna work.

It still could.
If we attach the muscle

further down the forearm
and bypass the scar ball.

It wouldn't hold.

There'd be too much tension
on the graft.

We can figure out a way
to work around that.

Let's wake him up and
put him back in his room

and pull every paper on
free-muscle and nerve transfers.

His only option
is double amputation

and the osseointegrated

We don't have a choice.

Yes, we do.

And as Chief of Surgery,
I just made it.

He doesn't really look the part.

He's a handsome guy
with a great sense of humor

and a high-paying job.

He means
because women don't like

to be in relationships
with men who are weird.

He's not weird.
And neither are you.

And a week ago,
you were juggling two women,

so stop feeling
so sorry for yourself.

Have you ever dated
anyone who wasn't tall,

handsome, and neurotypical?

It's not about me.

Talk to me.
He stopped breathing,

and I haven't even
administered the paralytics.

What just happened?

Pressure on the medulla
must be getting worse.

He's lucky he didn't wait
any longer to come in.

Let's tube him and get to work.

Wait. Flex his head
into position again.

Extend his neck.

What's going on?

Flexing the neck offsets
the posterior compression.

But that should take the
pressure off, not make it worse.

Doesn't make any sense.

And we're not gonna do brain
surgery on him until it does.

I don't see anything different
in the flexed-neck views.

Should his C2 bone
be curved inward like that?

It could exacerbate the
narrowing on the front of his...

It's not significant.

Well, if his apnea's
getting worse

because of pressure from
the front as well as the back...

The treatment is the same.

Surgery to create more room
in the skull base.

It's not the same,
and stop interrupting me.

If we drill off
the C2 in the front,

as well as open the back,

we might not have to
resect the cerebellum.

He wouldn't have any speech
impediment or balance issues.

We'd have to approach
through his mouth,

a bacteria-rich environment,

which can't be fully sterilized.

There would be too high a risk
of a post-op brain infection.

So we figure out
another approach.

There's only one safe way
to access the C2.

Okay, so come up with
something outside the box.

No, that's a stupid
expression. There is no box.

And you are wasting
valuable time

just because
you want to be nice to her.


We should do the cerebellar
surgery before he has a fatal apnea...


I'm not being nice.

I'm using my experience
and judgment to make the call.

That's my job.

You are being nice.
And you're being a jerk.

You've got the night.

If you two can't come up
with a solution by morning,

we'll proceed
with the original plan.

Your patient's in desperate need

of an Oklahoma weather report?

I didn't even want
to be here today.

You should try
a martial arts class.

Focused distraction is key
to dealing with stress

and heartbreaks.

That's just
avoiding the problem.

Don't obsess over
what you've lost,

focus on what you've gained
from the relationship.

I hate to interrupt
group therapy,

but what if we approached

through the side of the neck?

We could transpose
the vertebral artery,

open up the spine laterally
to drill off the C2.

It would leave his spine
permanently unstable

and could cause a stroke.

There might be a way
to mitigate stroke risk.

And he'd still have
the instability and...

Come on, Shaun.

I need help, not criticism.

I have always supported you

when you were trying
to come up with

an unconventional
treatment option.

You supported me when
you thought I was right.

What do you guys think?

We gotta go.

We do?

We remove the scar tissue
and the nerves.

Then harvest nerves
from his upper arm

to rewire his forearms.

It'll improve his grip,

and with
the scar tissue removed,

the pain should decrease, too.

Does nothing to solve
the blood-flow problem

that's causing the scarring.

I'm sure we can come up
with a solve for that.

That's what you said last time.

And I was right.
We're making progress.

Would you two give us a moment?

We'll meet you in the Residents'
Lounge when we're done.

Are you
so against the prosthetics

because you think it's in
Tyson's best interest,

or because it's my idea?

You think I care
whose idea anything is?

You're a competitive person

working with the guy
who used to hold your job.

I'll admit my competitive
drive may kick up a notch

when we work together.

I'll also admit
that I admire the courage

of a guy who stumbled
a half-mile back to his house

after his arms were
ripped off by a combine.

He opened a door with his mouth

and dialed 911 with his nose,

and as long as he wants
to keep fighting,

I'm gonna fight along with him.

Which has nothing to do
with my ego.


That's all I wanted to confirm.

But I'm gonna start prepping
for the amputation

because that's the only
rational choice we have,

which I'm confident
you'll realize soon enough.

Make any progress?

Yeah, I figured out
a lateral approach,

but Shaun thinks it would
leave his spine unstable

and increase his risk of stroke.

I agree.
Yeah, me too.

There has to be a way
to mitigate the...

Dr. Browne?

These just got delivered.


Dash is a romantic.

Thought you hated romantics.

Yeah, he's...
He's teasing me.

I told him I thought guys
who sent flowers were lame.

We haven't even kissed yet.

What are you waiting for?

I don't know.


I enjoy being with him.

I forgot how funny he is.

Just... hasn't seemed like
the right time.

I'm more worried
about the stroke risk

than spinal instability,

so focus on fixing that.


And, Claire,
if he's the right guy,

stop holding out
for the right time.

Your vitals are stable.

The nurses will monitor you
during the night.

Your problem's simple to solve.

You just need
to ask someone else out.

Lea was special.

I'm sure she was.

But there are so many
others, just as special.

You just have to
get to know them.

No, I don't want to.

Yes, you do.

You think I don't know
how you feel?

Afraid of being rejected
because you're too...


Finally I decided, screw it.

I started talking
to every woman I saw.

Street corners,
elevators, grocery stores.

And I learned
I'm pretty good at it.

That's my gift.

Everyone has one.

They just.

Have to figure out what it is...

Okay. Code Blue!

Code Blue!

Murphy and I just inserted a
diaphragmatic pacemaker on Finn.

It'll only trigger
shallow breaths,

so he's at high risk
for pneumonia.

You got anything?

Yeah, I was thinking of using

a more inferior
transatlas approach.

That would minimize stroke risk.

That won't work.

It would destabilize
the C1-2 joint.

You did all you could.

Go home.

We'll do the original
cerebellar surgery

first thing in the morning.

So I'll be able
to work the farm.

We still need to find a way
to increase blood flow.

You should regain most of
your grip and forearm strength,

but you'd still be in some pain.

I-I can handle it.

Can you?

How can you know for sure?

As the years go by
and the pain doesn't stop,

will you change your mind?

Because it'll be too late.

What's wrong? What are
you... What are you feeling?

Like a horse
just kicked in my chest.

I need an echo
and pulmonary cath kit!

And page Lim, stat!

I think the last time that I was at
an actual punk-rock show was, uh...


Patti Smith.

Oh, my God!

I completely forgot about that.

You forgot getting
your ass tossed offstage

by a 60-year-old woman?


Remember what you said
when we picked you up?

Uh, oh, something about her
being, uh, thin but strong?

"Thin but wiry."


Okay, well, I, um...

I have an early surgery,

so I should probably get going.


Have a good night.

Good night.

I got an idea.

Actually, you had it first.

It's the right approach,
just the wrong route.

We go in from the back,
posterior transdural,

gently move your
spinal cord out of the way

so we can drill off
the misshaped C2.

There is a risk of paralysis,

but we would be monitoring
your spinal functions

to help avoid
any nerve injuries.

Let's do it.
Where do I have to sign?

You shouldn't sign anything.

Consenting to this surgery

would be incredibly
shortsighted and reckless.

It is one thing to take your bad
mood out on your colleagues,

but to try and undermine
my surgical advice...

My opinion's valid.

Well, thankfully, he disagrees.

He's risking paralysis
to be charming

because people expect
everyone to be perfect.

Everyone's opinion is valid

all the way until
we go into the patient room.

We are a team with one opinion.


I don't feel better!

I feel worse!

And doing the wrong surgery

is not going to help anyone.

I don't want to do it,
I'm going home.

You're not walking out
on your patient.

Or your team.

I still have two sick days

and 76 hours
of unused P.T.O.

You're not sick, and you're
in the middle of a case.

I don't care about
the case or the patient.

I don't care about anything.

I've had my heart broken twice

in the last few years.

You want to know what I did?

I came to work every day

and pretended
everything was fine.

Until, eventually,

I wasn't pretending anymore.

That's not helpful at all.

How about this?

Go back in there

and help Claire
prep Finn for surgery,

or you won't be my resident.

Or anyone else's
at St. Bonaventure.

And I know you care about that.

We were able to clear the clot,

but due to the restricted
arteries in your arms,

we're gonna need to keep
you on blood thinners...



The blood thinners

make the reconstructive
surgery impossible.

We have no choice
but to amputate.

I'm sorry.


I'm not letting you
cut off my arms.

I don't want false limbs.

I don't want to be that guy.

I want to be who I am.

You are the toughest,

most tenacious person
I've ever met.

And that is not gonna change

because we replace your hands
with titanium.

It's time to let go.



Any way you could draw a skull

with a cobra coming out of its
eyes while you're back there?

Would you settle for
a lame smiley face?

Because that is the
only thing I can draw.

There's my favorite nurse.

Did you check out
that Ethiopian place

I told you about last night?

Actually, I did,

and the kik alicha was delish.

Now, if you want
a truly life-changing meal,

you need to try Lennon's
on Sixth.

Is it expensive?

But worth it.

Now, it's all white
tablecloths and candles,

so you'll need a date.

How 'bout Dr. Murphy?

You told me yourself
he's a gifted surgeon.

That's pretty high praise.

And he told me you're cute.

Good luck today.


I totally teed you up.

All you had to do
was take a swing.

I'm not interested in her.

If she's not your type,

I'm sure there are plenty
of other cool nurses

roaming around here

who could make you feel better
about yourself.

He's miserable because he's
had two relationships blow up.

I don't think jumping into
another one is the answer.

No, no, no!

Finn, you can't
exert yourself like this.

Just take it easy.

I ran into a woman
in the cafeteria.

Real nice.
But seemed stressed.

Turns out that her boyfriend

is having spinal surgery, too.

Big coincidence, huh?

But get this.

He also has

I mean, what are the chances?

Nathalie, don't you dare.


Just slow down.

You called me
the love of your life!

I do love you!

Don't say that!

I don't want to hear
any more of your garbage.


You have to... listen.

You need to get back to
bed now, or you'll pass out.

What's up?

What are you doing in here?

Once you get a patient
on the table,

there's too much going on

to appreciate
what this place is.

Mm. It's nice.

It's perfect.

Time to scrub in.

This will be my last surgery.

Five months ago, I was
diagnosed with rheumatoid arthritis.

I'm not responding
to medication.

Why did you do that?

I felt like it.

It didn't change the fact
that he cheated on you.

It won't make your life
any better.

You can't control
how you feel about someone.

But you can control what
you do with those feelings.

I ended the relationship
on my terms.

More importantly...

It made me feel better.

A Louisville Slugger
to a Porsche?

It was insane.

I like her.

What is to like?

I don't know.

I just do.

A sudden complete loss
of any SSEP and MEP signals.

B.P. and heart rate
are tanking.

We've injured his cord.

Push high-dose steroids
and pressors.

Remove the retractor
to take the pressure off.

That's the last of the vessels
and nerves ligated.


Specimen bag.

We have healthy
bone-anchor sites.

Same here.

Time to give him
functional arms.

Not me.
Give it to her.

She's a third-year resident...

A talented one,
but I wouldn't...

I'm sure she's read every
article written on osseointegration,

spent countless hours
in the Skills Lab,

and could probably do this with one
of her own arms tied behind her back.


Get to work.

Push another milligram
of atropine.

We may have just paralyzed him
trying to avoid a stutter.

We won't know anything
until we wake him up.

Where's the pressure
still coming from?

Laterally now.

So if we remove the joints
of the C1 and C2 bones,

that should make enough room

so we could
drill off the odontoid.

We could replace them
with screws and rods

to stabilize his
spine. That's...

A good idea.

Yes, it is.

If he's not already paralyzed.

Colleen Brown.

Freshman year.

I took her
to the roller-skating rink

'cause I thought that's
what you're supposed to do,

take girls
to the roller-skating rink.

I didn't know
how to roller-skate,

she ended up leaving
with Bobby K.'s little brother.

Broke me up.

Couldn't go to school
for a week.

Convinced my mom that I was sick

for the first three days,

and the last two I spent
in a double feature all day...

Where's Poppa?
And Twelve Chairs.

To this day, I can quote
both films verbatim.

So you think I should've
stayed home for two more days?

No, I don't think
it would've mattered.

It doesn't make a difference.

And then I made a list

of all the things
that annoyed me about her.

The way she chewed her gum,

the way she used to sit in
the front row of every class

so that the teacher
would call on her

when she raised her hand,

the way she said,
"Excuse me?"

instead of just "What?"
or "Huh?"

None of it makes any difference.

Then why are you telling me?

Maybe it'll make you feel a
little bit better to know that,

what you're going through,

every other young man in the
history of the world has gone through.

You're trying to make it work
with Lea and with Carly,

and you're getting a little
beat up, and that's okay.

Join the club.

You're in the mix.
That's a good thing.

I'm proud of you.

You ready?

It's gonna take
some getting used to.

But they're the same nerves
you used before.

All you have to do is
think about using the arms

the way you normally would.


That's pretty cool.

It's not a beer,

but you got to start somewhere.

Now pinch your forefinger
and thumb and twist off the cap.

I-I can't feel the thing.

You'll get used to it.
You got this.


You want me to say
you were right?

About the patient, or you?

When you offered me a job,

you said it was to help me
get back on the horse.

But what you really wanted
was a mentor.

Which I'm fine with,

but I think maybe you feel
threatened by that need.

Well, maybe that's true.

But maybe also you
enjoy it a little too much.

Maybe because you're having a
hard time giving up being Chief.

Maybe we're both right.

How did it go?

Can you lift your arms for me?


I'm gonna push your arm,
and I need you to resist.

Good. More.


That's great.

You should make a full recovery.

Thank you.

H-How's Nathalie's hand?

There was no nerve
or tendon damage.

She'll be fine.

She's a good person.

A little spirited,

but that's what I loved
about her.

Are you going to try
to win her back?

I'm confident but not stupid.

You gotta know when
to call it, Dr. Murphy.

I mean, there's a-a whole world

of amazing people out there.

Don't get bogged down with
this notion of a soulmate.

Finn's exam was normal.

But I am not sure
it was worth the risk.

We did a good thing today.

Mostly because of you.

That's kind of you to say but...

Your commitment to your patients

reminds me of why
I got into medicine.

Being around you
makes me a better surgeon.

A better person.

Well, good night.

Good night.

You did good work today.

And I understand
you're leaving surgery.

And I know that's a...
That's tough.

But it's the right call.

No, I don't think it is.

I love operating.

So I'm gonna keep doing it
as long as I can.

I'm gonna have
the synovectomy surgery.

That's really stupid.

That's incredibly stupid.

Not every dream comes true.

You have other opportunities.

You have another chance.

Not everybody does.
Be grateful for that.

Pick another passion
and pursue that.

I'm doing the surgery.


Another, please.

Well, that's one way
to start the night off right.

Hello, Nurse Fletch.

You can call me Julie.

Are you here alone,
or are you meeting someone?

I'm alone.

Well, to us.

You have beautiful eyes.

Thank you.

Or did someone
just tell you that

that's a good opening line?

It's right in our backyard,

and I've never even been there.

- Have you?
- No.

It's, uh, time we unleash
our inner tree-hugger.

You're off next weekend.

I think we should
go to Yosemite.

What do you think?

Yeah, sounds fun.

I need to get me
some hiking boots.

And, uh, like a fleece.


Mm. I'm rocking the
full lumbersexual look.

'Cause I gotta blend in.

I hear a bear can spot
a tourist a mile away.


You okay?

Uh, you're, uh...

You're here, but, you know, not.

You're right.
I'm sorry.

It's... It's just been
a long week.

I'm a bit exhausted.

Yeah, I think I might
call it an early night.

Oh, you sure?

I... You know, we don't
have to go to the club.

We can chill here.
We can watch a movie.

I'm sorry.

I just...

I just think I should go home.



I want to smash your car up.

I think that's a bad idea.

I want to hurt you
the way you hurt me.

I'm s-sorry.




I can't.

I can't.

You acted like
you cared about me,

but you don't even respect me.

You're flaky.


And you can't keep a boyfriend.

And you can't keep a job.

And no one likes you.

And... And you're going to
end up alone,

and you deserve it!

Because you're a superficial,

selfish, and prejudiced person!

You ready to tell me
what's on your mind?

Not really.


I think I'm in love
with my boss.